Escala de competencias clínicas básicas para psicoterapeutas (ECCBP). Construcción y fiabilidad para Argentina / Basic Clinical Competences Scale for Psychotherapists (BCCSP). Construction and reliability for Argentina

Resumen A nivel internacional, se han elaborado modelos e instrumentos de evaluación de competencias genéricas y específicas; sin embargo, en Argentina los desarrollos han sido menores. Un relevamiento de psicoterapeutas locales concluye que al menos siete competencias clínicas básicas y cinco indicadores asociados a su desarrollo serían esenciales para desempeñarse como terapeutas (Crocamo, 2019). El objetivo de este trabajo fue construir un instrumento para su evaluación, denominado Escala de Competencias Clínicas Básicas para Psicoterapeutas (ECCBP). Para ello, se utilizó un diseño no experimental, transversal de tipo exploratorio en cuatro fases: (1) elaboración del sistema de evaluación; (2) redacción de ítems; (3) revisión de la versión preliminar; y (4) desarrollo del instrumento definitivo. Se aplicó el instrumento a 534 psicoterapeutas argentinos con título de grado de psicólogo. La versión definitiva quedó conformada por 122 ítems y para completarlo se requirieren aproximadamente 45 minutos. La elaboración de un instrumento local favorece el estudio sistemático del área y permite valorar de manera confiable la efectividad de los programas de entrenamiento.

Abstract At the international level, models and instruments for the evaluation of generic and specific competences have been developed; however, in Argentina the developments have been fewer. A survey of local psychotherapists concludes that at least seven basic clinical competencies would be essential to perform as therapists: diagnostic process and design, interventions and techniques, therapeutic bond, professional role, contextual variables and diversity, interview management and evaluation and completion of the process. Furthermore, five activities and experiences would be linked to their training, called associated indicators: basic training and updating, personal development and work on oneself, belonging to institutions and network of professionals, supervision, and personal and professional experience (Crocamo, 2019). Therefore, the objective of this work was to construct an instrument for its evaluation called Basic Clinical Competences Scale for Psychotherapists (BCCSP). To do this, a non-experimental, cross-sectional exploratory design was used in four phases: (1) development of the evaluation system; (2) writing of items; (3) review of the preliminary version; and (4) development of the final instrument. The instrument was applied to 534 Argentine psychotherapists with a degree in psychology. To attend to the particularity of each phase, three samples were used. The first one was composed of three psychotherapists summoned to participate in the selection of the different methodologies to evaluate each competence and indicator. For the second one, reviewers of the instrument made up of five therapists with different levels of professional experience summoned to assess the preliminary version of the instrument. And the third, to study the psychometric properties of the BCCSP, a snowball sample was used composed of 534 psychotherapists from 19 provinces of Argentina. As a result, different evaluation formats were incorporated in order to favor the effective evaluation of the variables, clinical vignettes, self-evaluation of perception of competences and questionnaire. A systematized procedure was carried out to review and refine the pilot version. The percentage of agreement between the reviewers of the instrument (Herrera Rojas, 1993) and the Aiken's V coefficient were calculated using software called Basic Visual Program for Aiken's V, developed by Merino Soto and Livia Segovia (2009). The final version was made up of 122 items and it takes approximately 45 minutes to complete it. The first part is composed of three vignettes which offer clinical descriptions with 15 questions for each situation. Finally, the responses are scored as correct / complete (2 points), correct / partial (1 point) or incorrect (0 points). Next, the self-assessment scale presents the following Cronbach's alpha coefficients Therapeutic link α = .833; Professional role α = .715; Contextual variables and diversity α = .853; Interview management α = .845; Evaluation and completion of the process α = .845 and Design, interventions and techniques II α = .797. Finally, the questionnaire was made up of 22 items: basic training and updating (5 items), personal and professional experience (5 items), personal development and work on oneself (4 items), supervision (4 items), membership in institutions and professional network (5 items). The answers collected will allow to obtain qualitative information on experiences or activities associated with the development of clinical competencies for psychotherapy. In the first place, it should be noted that the BCCSP is an instrument specially constructed for the local population and the study area that can be generalizable to other similar sociocultural contexts since the vast majority of evaluation models and studies have been developed in Anglo-Saxon countries. At the same time, due to the lack of local evaluation instruments, the BCCSP could become a valuable tool, both to be used in research activities and in training programs and educational monitoring.

Burnout Amongst Psychotherapists in India: A review

In the mental health field, research on burnout among psychotherapists has focussed on the causes, coping strategies and certain therapist or client characteristics that might promote feelings of burnout. A majority of these studies have been conducted in Western countries, with few featuring an Indian context, and there is a paucity of research concerning the consequences and cultural factors involved in therapist burnout. The present review aims to provide an insight into therapist burnout in an Indian context, concentrating specifically on the factors contributing to burnout and their impact. Research studies conducted from the year 2000 – 2020 on Google Scholar, PubMed and EBSCO Host were reviewed, using keywords that were a combination of the terms “burnout,” “psychotherapist” “therapist” “clinical psychologist” and “mental health professional” “stress in psychotherapists” and “psychotherapist well-being.” The available literature emphasizes a requirement for more research on therapist burnout in Asian contexts, particularly to understand the impact of burnout along with the role of process and personality factors and culture. The review also highlights the importance of therapist wellbeing and the need for provisions to protect therapists mental health.

Associations between countertransference reactions towards patients with borderline personality disorder and therapist experience levels and mentalization ability

Abstract Objective This exploratory study locates countertransference as a pan-theoretical concept, comprising of thoughts, feelings, and behaviors expressed or experienced by therapists toward their patients. It aims to understand the patterns of countertransference experienced in working with borderline personality disorder. Associations between countertransference reactions and therapist-related variables of experience and mentalization ability are also examined. Method Psychotherapists (n = 117) completed the Therapist Response Questionnaire to assess patterns of countertransference experienced with a representative patient diagnosed with borderline personality disorder. They also completed a measure of mentalization ability that examined self-related mentalization, other-related mentalization, and motivation to mentalize. Results The profile of responses across eight countertransference dimensions is discussed, with the most strongly endorsed reactions being positive/satisfying, parental/protective, and helpless/inadequate. More experienced therapists reported less negative countertransference reactions in select dimensions. Therapists' self-reported ability to reflect on and understand their own mental states was negatively correlated with a range of difficult countertransference experiences. There were few associations between their ability to make sense of others' mental states, the motivation to mentalize, and the strength of their countertransference reactions. Conclusion The implications for countertransference management as well as therapist training and development are highlighted.

Adherencia o deserción de adolescentes en psicoterapia por agresiones sexuales: la perspectiva de sus terapeutas / Adherence or Drop Out of Adolescents in Psychotherapy Due to Sexual Abuse: their Therapist's Perspective

Resumen Un alto porcentaje de adolescentes que asisten a psicoterapia por haber sido víctimas de agresiones sexuales desertan de su tratamiento, afectando así su proceso de superación. Existe escasa investigación respecto a qué precipita la deserción o favorece la adherencia en estos casos. Objetivo: describir características del sistema consultante y del proceso psicoterapéutico de adolescentes que han sido víctimas de agresiones sexuales que adhieren y que desertan de la psicoterapia, desde la perspectiva de sus psicoterapeutas, explorando sus similitudes y diferencias. Método: se realizaron entrevistas semiestructuradas a psicoterapeutas que atendieron 16 casos de adolescentes que han sido víctimas de agresiones sexuales, 8 que desertaron de la psicoterapia y 8 que adhirieron hasta el alta. Se realizó un análisis narrativo temático de las entrevistas. Resultados: las principales similitudes identificadas fueron contextos sociofamiliares multiproblemáticos, recursos personales en los adolescentes y una relación psicoterapéutica positiva. Las diferencias se enfocaron en los adultos responsables, quienes en los casos de deserción mostraban bajo apoyo, una relación más conflictiva con el adolescente, escaso involucramiento en la psicoterapia y una relación frágil con el psicoterapeuta. Los adolescentes que desertaron presentaron motivos de consulta no asociados con la agresión sexual y se caracterizaron por ser socialmente poco integrados, a diferencia de los que adhirieron. Discusión: los fenómenos de adherencia y deserción a psicoterapia son complejos y multifactoriales. Junto con factores asociados al sistema consultante, se destacan elementos del proceso psicoterapéutico que propician la adherencia, y que, por tanto, pueden ser abordados tempranamente para favorecer la adherencia a la psicoterapia.

Abstract A high percentage of adolescents who attend psychotherapy due to sexual abuse drop out of treatment, affecting the overcoming. There is little research on what precipitates desertion or promotes adherence in these cases. Aim: describe features of the consulting system and the psychotherapeutic process of adolescents who have been sexually abused who adhere and drop out of psychotherapy, in order to explore similarities and differences from the perspective of their psychotherapists. Methods: Semi-structured interviews were conducted with psychotherapists who attended 16 cases of adolescent victims of sexual abuse, 8 who deserted from psychotherapy and 8 who continued until discharge. Thematic narrative analysis of the interviews was developed. Results: the main similarities described were multiproblematic social and family contexts, personal resources in the adolescents and a positive psychotherapeutic relationship. Differences were focused on caretakers, who in the drop out cases showed low support and a more conflictive relationship with the adolescent, little involvement in psychotherapy and a poor relationship with the psychotherapist. Adolescents who deserted had consultation purposes not related with sexual abuse and low social integration, unlike those who adhered. Discussion: the phenomena of adherence and dropout of psychotherapy are complex and multifactorial. Along with factors associated with the consulting system, elements of the psychotherapeutic process that support adherence stand out, which can be addressed early in the process.

Epistemic Orientation Short Scale: Development and Validity Evidence in a Sample of Psychotherapists / Escala Breve de Orientação Epistêmica: Desenvolvimento e Evidência de Validade em uma Amostra de Psicoterapeutas / Escala Breve de Orientación Epistémica: Desarrollo y Evidencia de Validez en una Muestra de Psicoterapeutas

Abstract Epistemic orientation refers to the preferred mode of accessing and using knowledge and is a construct of growing interest in psychotherapy research. In this context, the main objective of this study was to develop and provide initial validity evidence for a brief measure of epistemic orientation in a sample of Brazilian psychotherapists. Participants were 674 Brazilian psychotherapists (78.5% female), aged between 22 and 78 years. Exploratory and confirmatory factor analyses were conducted on different subsamples to establish the structure of the measure. Results revealed an instrument consisting of three factors (Rationalism, Intuitionism, and Empiricism) with good psychometric properties and fit indices (X 2 = 1.92, GFI = 0.94, CFI = 0.95 and RMSEA = 0.06). Factors exhibited good internal consistency and convergent and discriminant validity. Criterion validity was evaluated by examining the scale's ability to detect differences in the epistemic orientation dimensions as a function of therapist's theoretical approach. Overall, the scale proved to be a valid self-report measure for investigating personal epistemology.

Resumo A orientação epistêmica refere-se ao modo preferido de acesso e uso do conhecimento, sendo um construto de crescente interesse em pesquisa em psicoterapia. Nesse contexto, o objetivo principal do estudo foi desenvolver uma medida breve de orientação epistêmica e fornecer evidências iniciais de sua validade em uma amostra de psicoterapeutas brasileiros. Participaram 674 psicoterapeutas brasileiros (78,5% mulheres), com idades entre 22 e 78 anos. Conduziram-se análises fatoriais exploratória e confirmatória em diferentes subamostras para estabelecer a estrutura da medida. Os resultados revelaram um instrumento composto por três fatores (Racionalismo, Intuicionismo e Empiricismo) com boas propriedades psicométricas e índices de ajustamento (X 2 = 1,92, GFI = 0,94, CFI = 0,95 e RMSEA = 0,06). Os fatores apresentaram boa consistência interna, validade convergente e discriminante. Avaliou-se a validade critério mediante a identificação de diferenças nas dimensões de orientação epistêmica em função da abordagem teórica do terapeuta. Em geral, a escala demonstrou ser um instrumento de autorrelato válido para investigação da epistemologia pessoal.

Resumen Orientación epistémica se refiere a la forma preferida de acceder y usar el conocimiento, siendo un constructo de creciente interés en investigación en psicoterapia. En ese contexto, el objetivo principal del estudio fue desarrollar y proporcionar evidencia inicial de validez para una corta medida de orientación epistémica en una muestra de psicoterapeutas brasileños. Participaron 674 psicoterapeutas brasileños (78.5% mujeres), con edades entre 22 y 78. Análisis factoriales exploratorio y confirmatorio fueron realizados en diferentes sub-muestras para establecer su estructura. Resultados revelaron un instrumento con tres factores (Racionalismo, Intuicionismo y Empiricismo), buenas propiedades psicométricas e índices de ajuste (X 2 = 1.92, GFI = 0.94, CFI = 0.95 y RMSEA = 0.06). Los factores demostraron buena consistencia interna, validez convergente y discriminante. La validez de criterio se evaluó mediante su capacidad para detectar diferencias en las dimensiones de orientación epistémicas como función del enfoque teórico del terapeuta. En general, la escala demostró ser una medida de autoinforme válida para investigar la epistemología personal.

Cuestionario de estilo personal del terapeuta: Análisis factorial confirmatorio de modelos rivales con psicoterapeutas Argentinos / Personal style of the therapist questionnaire: confirmatory factor analysis with Argentinian psychotherapist

Resumen El objetivo fue evaluar las propiedades psicométricas de cinco versiones distintas del Cuestionario de Estilo Personal del Terapeuta (ETP-C), el cual indaga cinco funciones de la actividad terapéutica: Atencional (búsqueda de información), Operativa (intervenciones terapéuticas), Instruccional (establecimiento del encuadre terapéutico), Expresiva (grado de expresividad emocional) y de Involucración (compromiso). Para este estudio participaron 471 terapeutas de Argentina, quienes completaron la versión original del ETP-C, compuesta por 36 ítems. Luego se compararon los indicadores de ajuste de los cinco modelos disponibles del cuestionario. Se obtuvo que la versión portuguesa del EPT-C compuesto por 20 ítems, es el que mejores indicadores de ajuste presenta a pesar de que la confiabilidad del mismo no fue satisfactoria. Se discuten implicaciones teóricas y prácticas para la investigación en psicoterapia.

Abstract The objective was to evaluate the psychometric properties of five different versions of the Personal Style Therapist Questionnaire (PST-Q), which evaluate five functions of therapeutic activity: Attentional (seeking information), Operational (therapeutic interventions), Instructional (establishment of the therapeutic setting), Expressive (degree of emotional expressiveness) and Involvement (commitment).471 therapist participate in this study, who completed the original version of the PST-Q, consisting of 36 items. Adjustment indicators of the five models PST-Q available were then compared. As a result, the version of the PST-Q with best adjustment indicator was the Portuguese one made of 20 items, although the reliability was not satisfactory. Theoretical and practical implications were discussed for psychotherapy research.

A infância (re)contada pelo fio da memória de psicoterapeutas septuagenários / Childhood (re)counted by the threads of memory of septuagenarian psychotherapists / La infancia (re)contada por el hilo de la memoria de psicoterapeutas septuagenarios

Este estudo teve por objetivo investigar os relatos de psicoterapeutas idosos sobre sua infância, buscando identificar, nas experiências de vida narradas, elementos relacionados às vivências familiares. O estudo é de caráter descritivo e exploratório, de abordagem qualitativa com a utilização do método clínico-qualitativo. Participaram cinco psicoterapeutas septuagenários, escolhidos pelo critério de prestígio desfrutado junto aos pares dentro e fora de instituições psicanalíticas. Foi utilizada entrevista aberta, audiogravada e, posteriormente, transcrita na íntegra. Os relatos foram submetidos à análise de conteúdo temática. Os dados foram interpretados com base no referencial teórico psicanalítico da transmissão psíquica. A análise resultou na construção de três categorias temáticas: (1) A família como rede simbólica que define a posição subjetiva de seus membros; (2) Entre a reverência e a rebeldia: a possibilidade de reinventar a tradição familiar; e (3) Construindo o pertencimento à cadeia geracional. Constatou-se que as narrativas dos psicoterapeutas sobre a infância se estruturaram em torno da vida familiar, pautada em hábitos e papéis familiares bem delimitados, com rígida divisão de funções entre pai, mãe e filhos. A posição ocupada pelo sujeito na fratria e a submissão a um mito fundador da linhagem são elementos que auxiliam na compreensão do engendramento de cada participante na cadeia intergeracional.

This study aimed to investigate reports of elderly psychotherapists about their childhood, seeking to identify, through the reported life experiences, elements related to family experiences. This is a descriptive and exploratory study with a qualitative approach, using the clinical-qualitative method. Five septuagenarian psychotherapists participated, chosen by the criterion of prestige recognized by peers in and outside psychoanalytic institutions. Open-ended interviews were used, which were audio-recorded and subsequently fully transcribed. The reports were processed through thematic content analysis. The data were interpreted with the support of the psychoanalytic theoretical framework of intergenerational psychic transmission. The analysis resulted in the construction of three themes: (1) The family as a symbolic network that defines the subjective position of its members; (2) Between reverence and rebellion: the opportunity to reinvent the family tradition; and (3) Building the belonging to the generational chain. It was found that the psychotherapists' narratives about childhood were structured around family life, based on habits and well-defined family roles, with a strict division of functions between father, mother and children. The subject's position in the brotherhood and submission to a founding myth of the lineage are elements that help to understand the formation of each participant in the intergenerational chain.

Este estudio tuvo el objetivo de investigar los relatos de psicoterapeutas ancianos sobre su infancia, buscando identificar, en las experiencias de vida narradas, elementos relacionados con experiencias familiares. Se trata de un estudio descriptivo y exploratorio, con enfoque cualitativo, utilizando el método clínico-cualitativo. Participaron cinco psicoterapeutas septuagenarios, elegidos por el criterio de prestigio disfrutado junto a los pares dentro y fuera de instituciones psicoanalíticas. Se utilizó entrevista abierta, audio-grabada y, posteriormente, transcrita por completo. Los relatos fueron sometidos al análisis de contenido temático. Los datos fueron interpretados con base en el referencial teórico psicoanalítico de la trasmisión psíquica. El análisis resultó en la construcción de tres categorías temáticas: (1) La familia como red simbólica que define la posición subjetiva de sus miembros, (2) Entre la reverencia y rebeldía: la posibilidad de reinventar la tradición familiar; y (3) Construyendo la pertenencia a la cadena generacional. Se constató que las narrativas de los psicoterapeutas sobre la infancia se estructuraron alrededor de la vida familiar, basada en hábitos y roles familiares bien definidos, con una estricta división de funciones entre padre, madre e hijos. La posición que ocupa el sujeto en la fratría y la sumisión a un mito fundador del linaje ayudan a comprender la articulación de cada participante en la cadena intergeneracional.

Ser e tornar-se Psicoterapeuta parte I: diálogo entre experiências pessoais e profissionais / Being and becoming a Psychotherapist part I: dialogue between personal and professional experiences / Ser y tornarse Psicoterapeuta parte I: diálogo entre experiencias personales y profesionales

O psicoterapeuta tem sido considerado um elemento de primordial importância para o sucesso da psicoterapia no entanto, o estudo das suas características pessoais e profissionais tem sido negligenciado na investigação. O objetivo do presente artigo é analisar as narrativas de 20 psicoterapeutas experts (peritos) de diferentes orientações teóricas (cognitivo-comportamental, construtivista, humanista, psicanalítica e sistémica) sobre o seu desenvolvimento pessoal e profissional no decurso da prática clínica. Os dados foram recolhidos através de uma entrevista semiestruturada e foram analisados em uma perspetiva construtivista da grounded theory. Na análise emergiram dois grandes temas. Serão apresentados aqui os resultados do primeiro tema analisado, relativo às experiências relacionais do âmbito pessoal e profissional que contribuíram para o desenvolvimento dos psicoterapeutas. O tema organizador das entrevistas sublinha a importância do diálogo e da coerência entre o self pessoal e profissional na compreensão do desenvolvimento do psicoterapeuta....(AU)

The psychotherapist has been considered an element of major importance for the success of therapy, however the study of his/her personal and professional characteristics has been neglected in research. The purpose of this work is to analyze the narratives of 20 psychotherapists experts from different theoretical orientations (behavioral-cognitive, constructivist, humanistic, psychoanalytic and systemic) on their personal and professional development during clinical practice. Data were collected through a semi-structured interview and analyzed in a constructive perspective of grounded theory. In the analysis two main themes emerged. In this article are presented the results of the first theme, relating to experiences of personal and professional context that contributed to the development of psychotherapists. The organizing theme of the interviews emphasized the importance of dialogue and the consistency between the personal and professional self-understanding of the development of the psychotherapist....(AU)

El psicoterapeuta ha sido considerado un elemento de primordial importancia para el éxito de la psicoterapia; no obstante, el estudio de sus características personales y profesionales ha sido negligenciado en la investigación. El objetivo del presente artículo es analizar las narrativas de 20 psicoterapeutas experts (peritos) de diferentes orientaciones teóricas (cognitivo del comportamiento, constructivista, humanista, psicoanalista y sistémica) sobre su desarrollo personal y profesional en el transcurso de la práctica clínica. Los datos fueron recogidos a través de una entrevista semi-estructurada y fueron analizados en una perspectiva constructivista de la grounded theory. En el análisis emergieron dos grandes temas. Serán presentados aquí los resultados del primer tema analizado, relativo a las experiencias relacionales del ámbito personal y profesional que contribuyeron para el desarrollo de los psicoterapeutas. El tema organizador de las entrevistas subraya la importancia del diálogo y de la coherencia entre el self personal y profesional en la comprensión del desarrollo del psicoterapeuta....(AU)

Tratamento cognitivo-comportamental para o transtorno de pânico e agorafobia: uma história de 35 anos / Cognitive-behavioral therapy for panic disorders and agoraphobia: 35 years of history

Este artigo descreve a evolução do conhecimento sobre um tratamento cognitivo-comportamental do transtorno de pânico e da agorafobia. É baseado em contribuições de vários pesquisadores e descrito como um tratamento integrativo na medida em que associa tratamento farmacológico e vários tipos de intervenções cognitivas e comportamentais. Utiliza técnicas de reestruturação cognitiva, habituação interoceptiva, técnicas respiratórias, de exposição situacional e reestruturação existencial. O tratamento foi originalmente desenvolvido para atendimentos individuais, mas depois foi também utilizado para atendimentos em grupo. Foi concebido para ser um atendimento que pudesse ser desenvolvido por terapeutas que trabalhassem em locais onde não existisse uma terapia cognitivo-comportamental qualificada, em um modelo de tratamento passo-a-passo. Os resultados têm sido muito satisfatórios, com exceção de algumas intervenções, como o treinamento em assertividade e o relaxamento muscular. Ajustes foram realizados para atender esses achados.

This paper describes the evolution of knowledge of cognitive-behavioral treatment of panic disorder and agoraphobia. It is based on contributions by diverse researchers, and it is described as an integrative treatment inasmuch as it combines pharmacological treatment and various types of cognitive and behavioral therapies. It uses cognitive restructuring techniques, interoceptive habituation, techniques for breathing, situational exposure and existential restructuring. The treatment was originally developed for an individual approach, but it was also later used with group treatments. It was conceived as a treatment to be used by therapists working in places where it would not be possible find qualified cognitive-behavioral treatment, in a step-by-step treatment model. Results have been most satisfactory with the exception of some interventions such as assertiveness training and muscular relaxation. Adaptations were made to cater to these findings.

A Multi-Center Survey on Dual Relationships and Associated Factors among Chinese Counselors and Psychotherapists / 中国医学伦理学

Objective: To explore the dual relationships and associated factors among Chinese counselors and psychotherapists.Methods: 1000 participants were investigated by a self-made questionnaire composed of ethical problems in psychotherapy and counseling.Results: The main dual relationships between counselors/psychotherapists and clients were the association of friends.Thirty-two percent of participants provided counseling or psychotherapy to their friends.To the item of "providing counseling or psychotherapy for their friends,students,supervisee,employees",the judges of ethical beliefs of participants were inconsistent,and forty-one percent of them thought that such behaviors were ethical.These items were the main associated factors,such as gender,the duration time of professional experience,the title of a technical post,the different experience of training,prescription,and medicine.Conclusion: The present state of nonsexual dual relationships between counselors/psychotherapists and clients are not rare,and the ethical beliefs of some participants in dual relationships were blurring.It is necessary to intensify the professional education,unify the ethical code,and accept the help of psychotherapy and supervision,in order to improve the current states of Chinese counselors and psychotherapists.